Description of the Cape Care Project

Cape Care represents a proposed, not-for-profit universal health care insurance program, covering all residents of the Cape and Islands for comprehensive, accessible and affordable health care, with free choice of all participating providers.

The model is, essentially, a social insurance system. Access to health care is recognized as a human right, available to all. The parallels with other available services such as Fire and Rescue coverage, libraries, schools, Town recreation areas and others are illustrative of this model.

Cape Care would be professionally administered. It would be governed by a Health Policy Board, representing the community, sharing responsibility with a Medical Advisory Board of health care providers. The Boards would oversee administration and develop policy through a transparent public process. It should be a conscious goal of the health care delivery system, though the mechanism of the Health Policy and Medical Advisory Boards, to facilitate access to all appropriate screening and preventive health services and to provide equitable, high-quality care to all.

Within the Policy Board's mandate to set coverage and reimbursement rates, is the means to assure that the needs of the residents of the region for appropriate medical services are met. This particularly includes the standardization of well-validated preventive health interventions, as well as mental and dental health care coverage. The Board would set the universal benefit package for all enrolled residents, and any extra-cost benefit options. And it would be charged with maintaining adherence to a defined Mission Statement, reflecting the agreed-upon guiding principles of appropriate health care service access.

The essence of the financial basis for the model, is the re-direction of the many health expenditures we now pay, in a variety of taxes, charges and out-of pocket costs (at a higher cost than any system in the world.) Barnstable County, or possibly a new multi-county regional authority , would establish, and oversee, the Community Health Insurance Fund, derived from new revenue stream(s). This would probably include health insurance premiums to build and sustain this fund. Such premiums should be progressive, meaning that the proportion of income directed to health care costs would be lowest for those of least income- the exact reverse of current financing. This would have the effect of increasing disposable income for the individuals and families most in need

From this Fund, provider claims would be paid via a greatly simplified process. Substantial cost savings are based principally on the reduction in administrative overhead and the elimination of insurance profit, and are projected to be sufficient to cover all residents (including the current uncovered) with an comprehensive benefit package. In addition, pharmaceutical purchasing will utilize the saving power of volume buying, as well as working with existing buyer networks, to provide a covered formulary as a standard benefit.

Longer-term savings are projected in actual health care expenditures. Our population, covered for access to primary care for preventive and health maintenance services, can be expected to show improvements in public health indicators (i.e. better health!) Such outcomes result in savings both human and financial.

All residents will be covered, independent of employment or means. Employers would have no financial responsibility for the health care of their resident employees.

For those individuals covered under Medicare, MassHealth and similar programs, Cape Care would give them free choice of all affiliated providers, with greater benefits likely as well.

There is no change envisioned, in the ownership or governance of any health care provider- institutional, group, or solo. All health care providers currently certified to receive Medicare, MassHealth (and other) insurances would be eligible to enroll, through a standard Provider credentialing process. With most patients covered by a single, administratively straightforward insurance, providers will experience cost reductions and improved income. And, as the great majority of individuals would be covered by Cape Care, there will be a strong incentive for providers to enroll.

Administration will emphasize simplicity and efficiency. Covered services and benefits would be a uniform package, and understandable. Claims processing would be much less complex than presently, with no cost-shifting. Based on validated claims submitted to Cape Care, vouchers would direct prompt payment by the Health Insurance Fund to providers. A simple fraud control process would be based on beneficiary verification, of receipt of services paid on their behalf.

The feasibility of this model has been demonstrated in functioning health care systems around the world, and in studies in many states. More care, for all, at a cost less than what we now spend and with much greater control over the content and quality of that care. A model for how it could be better. This is what Cape Care could be. It will be ours to create.